Northwest University Buntain School of Nursing
Nursing 3432 –Management and Leadership
Home Preparation Assignment for April 13, 2013
Directions: These are to be prepared PRIOR to the Saturday Seminar and brought to the Seminar for
group discussion. Use your Marquis and Huston’s text, Leadership Roles and Management Functions in
Nursing, 7th Ed. to prepare each of the learning exercises listed below. Also prepare the four case
studies enclosed.
(1) Each student will prepare ALL of the Learning exercises. This is not a group assignment.
(2) These must be typed. You will want to leave a margin to take legible notes during the group
discussion with panel members during the Saturday Seminar. It does not need to be APA—
no need for a separate reference page. Use your text as a reference where needed—note in
answer / discussion. Use correct punctuation, grammar and spelling.
(3) Be brief and succinct, but thorough. It is not necessary to copy the learning exercise or case
study onto your paper. However, make sure your paragraphs are labeled as to which group
and which case study number one you are answering (i.e. Group A, Learning Exercise 16.8).
IMPORTANT: Group and answer them as they are sequentially grouped below.
(4) These will be handed in at the end of the Saturday seminar, with notes in the margins that
you may make as you interact with your nurse leader. This is a graded assignment. You
will be graded on your answers PLUS the notes you take.
(5) Each group will rotate between each panel member who has prepared a selection of these
learning exercises and case studies to review and discuss with your group.
Prepare these in the following groupings:
Group A
Learning exercise 16.8 pp. 375
Case Study: Authority and Responsibility*
Group D
Display 15.4 pp. 335 Case 1 and Case 2
Learning exercise 16.9 pp. 375
Group B
Learning exercise 24.2 pp. 549
Learning exercise 2.5 pp. 507
Group E
Case Study: Staffing and Nursing Care **
Case Study: Head Nurse Power ***
Group C
Learning exercise 19.6 pp. 439
Case Study: Organizational Power****
Group F
Learning exercise 4.3 pp. 79
Learning exercise 4.9 pp. 89
Group G
Learning exercise 5.5 pp. 105
Learning exercise 4.6 pp. 87
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GROUP A:
Learning Exercise 16.8 (p. 375):
(Addressing Resocialization Issues):
This problem may not have been prevented, however the transition could have been made smoother.
Even though Brian went through a 3-week orientation, I believe meeting with him individually could
have been extremely beneficial by opening up the opportunity for better communication as well as
discussion regarding the home health agency’s philosophies, approaches to care, and values. This
may have equipped Brian for understanding client’s needs and expectations, as well as the culture of
the agency’s care. “Employees adopting new values often eperience role strain and managers need to
support employees during this value resocialization…By instilling and clarifying organizational
values, managers promote a homogenous staff that functions as a team” (Marquis & Huston, 2012, p.
366). I believe the manager could have done a better job at evaluating the situation by assessing the
needs of the nursing team and patients, as well as the gifts, talents, and weaknesses of Brian and
coming up with strategies to assist in a smooth transition, while capitalizing on his strengths. Taking
on this approach as a manager allows Brian to feel valued, while still remaining true to the culture,
values, and vision of the agency and the health care team.
So in that case, prior to orienting, as a manager I would sit down with Brian and assess
strengths, weaknesses, goals, and communicate with him regarding the agency and their approach to
health as well as his job description and expectations. This sets a foundation of accountability to be
established. Not only that, but as a manager it creates a safe environment to communicate and make
yourself available and approachable to employees. After discussing his goals and evaluating the
needs of this transition, I would come up with strategies and a plan with him as well as my other
employees to make this transition as smooth as possible. After Brian orients and begins working
unsupervised, I would continue to make time periodically to meet with him as well as other
employees to check up on his progress, concerns, etc. And from their we would re-evaluate the
situation, and continue to make goals accordingly.
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*Case Study: Authority and Responsibility (taken from H.E. Grohar—Murray & H.R.
DiCroce (2003) Leadership and Management in Nursing p. 145.)
A small neurosurgical unit, which up until recently displayed good interpersonal relationships
among the nurses and nurse aides has suddenly developed problems. Because other hospitals in the
vicinity have closed their neurosurgery units, the census of this unit has continued to increase and is
usually maximally occupied. In the past, the nursing staff worked cooperatively, but recently the staff
stopped working as a team. The nurse aides are expected to take eight patients, and the nurses are
assigned five patients. The nurse aides have stopped completing their job responsibilities, such as
bathing patients and changing beds. The nurses subsequently have had to complete the nurse aides
work. This has led to poor working relationships between the two groups. The nurse manager spoke
to the nurse aides at the request of the nurses a number of times. Each time, the nurse aides
improved their performance for a day or two, and then fell back into the same pattern of not
completing their work. The tension between the nurses and nurse aides continues to rise and the
situation remains unresolved.




Who is most responsible to correct the situation?
What forms of power are being used in this situation?
Would creating a work team composed of specific nurses and nurse aides be helpful?
What situational forces led to this situation? Can they be addressed?
I don’t believe there is any one person with more responsibility in this situation. Collaborative
care rests on the principle of collaboration and and effort put forth by the team, therefore I believe
everyone is held responsiblie in this situation to correct it, or encourage their team members in their
work- not in an offensive approach but gentle.
Power is being used by the nurse manager to try and enforce the nurse aides to complete their
work. I think a constructive way of tackling this issue resulting from a higher census and higher
responsibility would be to sit down as a team and develop strategies for tackling the problems at
hand. Giving the nurses and nursing aides an opportunity to express their concerns and frustrations
in a respectful way and controlled setting can help guide the team in what areas to focus on as well as
how cohesiveness may improve relations between team members. I believe creating a work team
composed of specific nurses and aides would be helpful in order to develop care teams that are
familiar with each other. However, I feel that conducting group meetings to develop strategies may
be more efficient in that you wouldn’t have to always rely on the same team members working the
same time. This plan may offer more room for flexibility.
The situational force that led to this situation arising was that the demand increased (other
neurosurgical units closing) without the supply, or the preparation of the supply (being the one
neurosurgical care unit). I believe these can easily be addressed by discovering what the new need
is for the unit in order for them to work efficiently and deliver quality care.
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GROUP B:
Learning Exercise 24.2 (p. 549)
The positive forces already present include patient satisfaction with her care, as well as her genuine
compassion and diligence to follow through with patients needs. Mrs. Jones is also a hard worker
and gets along well with her employees. The negative forces that need to be overcome is Mrs. Jones
reliance on other nurses to make decisions, autonomy and confidence in her ability will be a goal. It
will also be a goal that Mrs. Jones will be able to draw appropriate boundaries on her workload and
what she agrees to take on with in her team in order to prevent her being taken advantage of.
In my performance-appraisal it will be my goal to be as objective as possible while taking the time,
and making it a priority to listen to Mrs. Jones thoughts. “Since performance standards should be
based upon observable behaviors, appraisal should be based upon observed behavior as well”
(Marquis & Huston, 2012, p. 558). This being said, I will maintain focus on patient’s feedback on her
care. In order to deliver feedback on things for Mrs. Jones to work on I will be straightforward in
offering constructive and objective feedback regarding Mrs. Jones confidence and autonomy in
working independently in a clear way rather then trying to avoid the topic. According to Marquis &
Huston, this will allow for a clearer message and more honest communication (2012, p. 558).
Learning Exercise 2.5 (p. 507)
Careful consideration and sensitivity of all variables need to be taken when dealing with a situation
like this. Fifty years of nursing experience obviously brings a great asset to any team. Not only that,
but according to the doctor, nursing is the very thing maintaining Mary’s quality of life and without it,
her life may proceed to deteriorate if she is let go. Knowing of the Age Discrimination in Employment
Act, there is no basis for me to be able to fire her on the premise of age (Marquis & Huston, 2012, p.
507). However, knowing my responsibility to my patient’s safety and my managerial responsibilities
despite Mary’s age, I would need to address her recent mixup of preparing the baby girl for
circumcision. I would do this in a direct manner of addressing responsibility, yet showing grace and
appreciation by ensuring her of her value to the unit. I would also want to talk with her and assess
her own perception of how she is able to fulfill her job duties and whether we can come up with a
personalized schedule or plan to help her deliver the best care she possibly can.
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GROUP C:
Learning Exercise 19.6 (p. 439)
As a sister and a health care profession bound by the laws of HIPAA, this puts ‘me’ in an extremely
tough position. My obligations to this patient are to maintain his privacy and confidentiality not only
regarding his identity, but his health status according to HIPAA laws (Marquis & Huston, 2012, p.
558). However at the same time, this is information that I would hope for my sister to know and be
aware of if it were to be true. Yet at the same time, I honestly believe I would continue to protect my
patients’ rights to privacy and not disclose this information. I believe that if it’s truly God’s will for
them to marry, then He will disclose that information at some point. It would be interesting to see
the response of the client once he ends up finding out that he was dating the sister of the nurse he
disclosed this information to, and whether he would choose to screen further or not.
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****Case Study: Organizational Power (taken from H.E. Grohar—Murray & H.R. DiCroce
(2003) Leadership and Management in Nursing p. 146.)
A new policy was posted on the nurses’ station of the nursery. The sign read: “ To protect
patient privacy and confidentiality, no families or patients are allowed beyond this point.” The
evening nurse read the policy and proceeded to care for the babies. It was an especially busy
evening, and one of the infants, whose family had a difficult time coming to the hospital, needed
attention and a feeding. The nurse, who was behind in charting, decided to take the infant to the
nurse’s station and chart while holding and feeding the baby. She was approached by the charge
nurse who informed her of the policy and to kindly comply. The nurse took the baby back to its room
for care, and stayed overtime to finish charting and working.
 What do you think of the policy?
 Do conditions change the interpretation of a policy?
 What else could have been done in this situation?
Note: Some policies while well intentioned and appropriate have to take into consideration the
existing work climate and culture. Modifications may need to be in order, such as the time of
enforcement or providing barriers to allow the work to be done properly while maintaining the
confidentially of individuals.
I think this policy seems appropriate for not only maintaining patient privacy and confidentiality but
also professionalism. Although I have never worked in a nursery or infant center in order to know
the demand of the job and as to whether this is a reasonable request in order to fulfill job duties. A
new policy such as this may require more demand from the health care team, and without adequate
preparation, this policy may be breached or quality of care may be sacrificed at the cost of upholding
the policy. As the note suggests, I would probably reassess the ability of the nurses to complete work
and maintain the policy and what modifications need to be in order for work dynamics. I don’t
believe that conditions change the interpretation of a policy and that it is important that the policy be
respected. Something I believe could have been done differently is that the nurse possibly delegate
this duty to an aid or another nurse if they were not as busy, that way she could finish her other
documentation duties.
GROUP D:
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Display 15.4 pp. 335 Case 1 and Case 2
Prior to giving Mr. Jones anymore morphine, I would want to ensure that his respiration rate and
oxygen saturation levels were high enough in order to prevent further sedation or CNS depression. I
would assess whether he is arousable and can tell me if he needs more pain medication. If his
Oxygen saturation was above 95% and respirations were above 12 I would look at giving him
another dose of 8 mg in possibly 15 minutes if he continues to complain. Though I really don’t have
much experience with pain management using narcotics, so I’m not entirely sure what would be most
appropriate, though based on my knowledge and experience—that is what I would do.
I would respectfully approach the LPN about her honesty earlier. I would approach her in a
respectful and gentle way understanding that she is tired from the night before. Though reminding
her of how important it is to be able to physically and mentally deliver competent and safe care to
clients. I would maybe enourage her to make decisions as to whether she is able to work in the
future if this situation arises again or if a replacement needs to be found in order to provide safe and
quality patient care. Not only is ensuring safe and quality care important, but promoting good selfcare for this LPN is important as well. She needs to be able to determine what decisions would be the
best for her own health and well-being as well and whether working on no sleep would assist in that.
Learning exercise 16.9 pp. 375
I would try my best to evaluate and dissect the older nurses’ comments and their validity. This
would help me in coping with the situation to try and find constructive feedback if possible. Though
comments like this begin to get a little discouraging especially as a new nurse, so I don’t feel being
passive in this situation would be the best for my confidence in the position nor the care of my
patients. I think the best way of trying to resolve this situation and improve my relationship with my
co-worker is to approach her and ask her if there is any constructive feedback she could offer to help
improve the quality or efficiency of my care. I would probably also address her comments and how
that has upset me and discouraged me as I continue to gain experience. If this goes well and no
problems continue to arise then I would let it be, however if she does retaliate I would involve my
charge nurse, especially since she found my first 3 months in the job to be satisfactory.
GROUP F:
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Learning exercise 5.5 pp. 105
At this point, I would advocate on the patients behalf and let the doctor know of Mrs. Jones specific
comments relating to her not having to go through surgical menopause. It is clear that despite
informed consent documents or the physicians’ discussion with her regarding risks, that there is a
clear need for further patient education. And prior to surgery being done, this misunderstanding
needs to be addressed for the best of the hospital as well as the best of the patient. If the physician
still continues to resist, I would let him know that based on her comments I can not let her continue
on with surgery until risks and benefits are reviewed by the physician himself. I would like to be able
to offer this education and clarification, however “nurses have to be careful not to give new
information that contradicts information given by the physician”(Marquis & Huston, 2012, p. 104).
So prior to sending her to surgery, I would require him to follow up with the client and do a second
document of informed consent that way full understanding is ensured.
Learning exercise 4.6 pp. 87
I believe the supevisor did a good job at problem solving the situation despite the outcome. One
thing I would have differed in, would be meeting with Beverly sooner and assess the situation as
soon as comments were made regarding Beverly and a possible drinking issue. There are confliciting
legal and ethical obligations in this situation. The legal obligations of the supervisor include seeking
out the best care of the patients, as well as policies held by employess; both of which were being
sacrificed or breeched due to Beverly’s drinking problem. However at the same time, hearing the
situation that Beverly faces with providing for her family also makes for a difficult ethical decision in
asking her to be dismissed and seek help. Despite the tough ethical decision this forces the
supervisor to make, I believe I too would have made the same decision in problem solving as painful
as it is to say, knowing the outcome of this decision. It was obvious that Beverly was already unable
to provide for her children since she was unable to do her job, and despite the hard ethical situation,
she needs to be held accountable to the responsibilities of her job. The manager has the greatest
obligation to the patients and the organization, as the patient’s safety is in the best interest of the
organization itself. It is hard to say whether the outcome could have been prevented or not. One
thing I may have done differently is be more intentional about following up with Beverly and more
personal in seeing if there’s anything I could assist her with in this time. “Outcomes should never be
used as the sole criterion for assessing the quality of ethical problem solving, because many variables
affect outcomes that have no reflection on whether the problem solving was appropriate” (Marquis &
Huston, 2012, p.87). As tough as that would be as the supervisor to not take responsibility of the
outcome, decisions can not always be held responsible for outcomes.
References
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Marquis, B.L. & Huston, C.J. (2003). Leadership roles and management functions in nursing: Theory
& application. (7th ed.) Philadelphia: Lippincott.
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